Photo Illustration by Elizabeth Brockway/The Daily Beast

The unveiling of the Tax Cuts and Jobs Act—née the “Cut Cut Cut Cut Act”—was pitched by Republican lawmakers on Thursday as a final step in their lengthy journey to deliver long-promised relief to American taxpayers.

The legislation, which would slash taxes for corporations by $1 trillion in its first 10 years and radically cut taxes for heirs to large family fortunes, was framed by House Speaker Paul Ryan as “real relief for people in the middle—and people who are also striving to get there.”

As currently written, the bill checks off dozens of boxes for congressional Republicans: condensing the number of tax brackets from seven to three; doubling the estate tax exemption to $10.98 million, before phasing it out entirely; killing the alternative minimum tax; raising the floor for the highest income tax bracket to $1 million; and cutting the corporate tax rate to 20 percent from 35 percent.

“With this plan, we are making pro-growth reforms so that yes, America can compete with the rest of the world,” said Ryan, adding that “we’re also making it so that families like these that are here can have more take-home pay.”

But buried within the text of the 429-page bill are provisions that Ryan didn’t mention at the legislation’s unveiling. Some policies, such as killing state and local income tax deductions and ending student-loan deductions, have been floated in the past as ways to slash tax rates without exploding the deficit. But other proposals contained in the Republican plan—from killing deductions for rare-disease research to ending tax benefits for adopting a child—would hit some vulnerable taxpayers where they least expect it.

Eliminated: Credits for Disability, Deductions for Age & Medical Expenses

Currently, individuals can deduct most out-of-pocket medical expenses that exceed 10 percent of their annual adjusted gross income—that is, taxable income minus deduction-based deductions. But under the proposed plan, that deduction would be eliminated. For individuals or families with high out-of-pocket medical bills, such as the elderly or the chronically ill, killing the deduction could mean major tax increases.

The deduction costs the U.S. Treasury roughly $10 billion per year.

The AARP came out against ending the deduction, which is largely utilized by seniors with low or fixed incomes and increasing medical costs. Calling the proposal one of several “areas of concern” within the Republican plan, AARP executive vice president Nancy LeaMond said in a statement that “eliminating the medical expense deduction amounts to a health tax on millions of Americans with high medical costs—especially middle-income seniors. AARP is strongly opposed to this provision.”

Even healthy elderly taxpayers face the eliminations of popular tax breaks. The House bill also repeals the 15 percent tax credit for all taxpayers 65 and older, who can cut up to $5,000 from their tax bills as an individual or up to $7,500 for married seniors. The same credit is utilized by taxpayers under 65 who are retired on permanent disability.

Made permanent in 2013 by President Barack Obama, the adoption tax credit offsets the tax burden of adoptive parents by up to $13,460 per child, with credit in excess of the parents’ tax liability able to be carried forward for up to five years. The credit covers adoption fees, court costs and attorney fees, travel expenses, and other expenses related to adoption both domestic and international.

The current plan proposed by congressional Republicans would eliminate that tax credit, making adoption difficult for all but the wealthy. According to adoption agency American Adoptions, the total cost of an agency-coordinated adoption in the United States can reach nearly $40,000. For foster parents, who often report having lower than average median incomes, the elimination of the tax credit may discourage the adoption of foster children.

According to the Joint Committee on Taxation, repealing the adoption tax credit would save the government $3.8 billion over 10 years, a little more than one-third the cost of a Ford-class aircraft carrier.

Adoption advocacy groups are incensed.

“We strongly encourage Congress to re-evaluate the true human and fiscal costs eliminating this will have on children awaiting adoption—and to the families that are willing to open their hearts and homes to them,” Chuck Johnson, president and CEO of the National Council For Adoption, told The Daily Beast. “These children are more important that shortening the time it takes to complete your taxes or the pros and cons of certain deductions and credits. It’s very rare when the morally right thing to do and the fiscally responsible thing to do come together in one policy, but the ATC is one of times where both come together at the same time.”

Some children, however, would benefit under Republican legislation—they just haven’t been born yet. The bill allows parents to create 529s, or qualified tuition plans, for beneficiaries the bill calls “unborn children.” In the plan’s summary, the term is specifically defined as “a child in utero… mean[ing] a member of the species homo sapiens, at any stage of development, who is carried in the womb.”

Eliminated: Deductions for Rare-Disease Research

In addition to ending deductions for medical expenses by individuals, the Republican tax plan kills deductions for pharmaceutical and biotechnology companies that run clinical tests for treatments of rare diseases. Currently, drugmakers can deduct 50 percent of the costs of those trials, incentivizing research into so-called orphan drugs, which treat diseases and conditions affecting fewer than 200,000 Americans.

For drugmakers, the credit allows research into treating and curing diseases that often wouldn’t otherwise be financially feasible. Among the ailments covered by the benefit include Huntington’s disease, muscular dystrophy, and cystic fibrosis.

Ending the deduction would, according to the bill’s summary, raise revenue by roughly $54 billion over a decade.

The National Organization for Rare Disorders, a nonprofit that advocates for research into rare diseases, slammed the proposal as “wholly unacceptable” and urged the estimated 30 million Americans with rare diseases to call their representatives in protest.

“The Orphan Drug Tax Credit is one of the most important incentives for developing therapies for individuals with rare diseases,” the nonprofit said in a statement. “A repeal of the Orphan Drug Tax Credit would directly result in 33 percent fewer orphan drugs coming to market, an unprecedented decrease in the development of these life-improving therapies.”

One of the diseases that would be affected by the proposal would be ALS, the neurodegenerative disorder for which President Donald Trump once made an Ice Bucket Challenge video as part of a 2014 fundraiser for the ALS Association. (Trump’s foundation gave $0 to the ALS Association that year.)

Eliminated: Deductions for Personal Casualties

Currently, the Internal Revenue Service allowed taxpayers to deduct uninsured losses related to the destruction of their home, household items, and vehicles in a federally declared disaster, or from “any sudden, unexpected, or unusual event” like a theft, flood, fire, or volcanic eruption (it happens!).

The deduction is so comprehensive that taxpayers whose uninsured losses exceed their annual income can continue deducting those losses in future years as a net-operating loss. This is how President Trump lost $916 million in 1995 and was then able to avoid paying income taxes for nearly two decades.

The proposed elimination of this deduction would be acutely felt by survivors of Hurricane Harvey, Hurricane Irma and Hurricane Maria, if not for a carve-out in the bill specifically exempting those three disasters from losing the deduction. But for those affected by future hyperactive Atlantic hurricane seasons, the financial impact of losing deductions for damage to uninsured property could be as catastrophic as the hurricanes themselves.

In Harris County, Texas, home of Houston, only 15 percent of homes were estimated to be covered by flood insurance issued by the National Flood Insurance Program. An estimated 30 percent of Harris County was submerged by the floodwaters.

Missing: Carried-Interest Loophole Closure

During the presidential campaign, Trump privately took heat from hedge funders when he unveiled a tax plan eliminating the carried-interest loophole, which allows private equity managers, venture capitalists, and real estate partners—like Trump himself—to get their earnings taxed at 23.8 percent, the same rate as capital gains, rather than at the highest marginal tax rate of 39.6 percent.

Under that part of Trump’s plan (since deleted), “carried interest will be taxed as ordinary income” to “ensure the rich will pay their fair share.”

For that reason, the president’s previous commitment to closing the loophole had drawn cautious praise from Democrats, including Senate Minority Leader Chuck Schumer, who vowed earlier this year to “work in good faith to perfect and potentially enact it.’

The current House proposal preserves the carried-interest loophole, the closure of which could raise as much as $180 billion over the next decade.